Cardiorespiratory Coordination in Cheyne-Stokes Respiration

Transcription

1 Cardiorespiratory Coordination in Cheyne-Stokes Respiration a case study P. Granitza, H. Krause, J.F. Kraemer and N. Wessel Cardiovascular Physics, Department of Physics, Humboldt-Universität zu Berlin 1 / 19

2 1 Cardiorespiratory Coordination Towards Cardiorespiratory Coordination Interpreting the Cardiorespiratory Coordigram 2 Cheyne-Stokes Respiration 3 Case Study Synchrogram vs Coordigram Fourier-Method 4 Future Research 2 / 19

3 Cardiorespiratory Coordination ESGCO 2016: Niels Wessel, Humboldt University, Germany: Cardiorespiratory Coordination During Sleep (Session 2) Figure: An exemplary Coordigram. 3 / 19

4 Towards Cardiorespiratory Coordination Common Basis of Coordigram and Synchrogram: Onsets Figure: Respiratory Onsets (I) and Heartbeats (R). 4 / 19

5 Towards Cardiorespiratory Coordination Figure: The coordigram is based in time-, the synchrogram in phase-space. 5 / 19

6 Towards Cardiorespiratory Coordination Overview: The Cardiorespiratory Coordigram 1 1 M. Riedl, et al. Cardio-Respiratory Coordination Increases during Sleep Apnea. In: PLoS ONE (4) e / 19

7 Interpreting the Cardiorespiratory Coordigram Interpreting the Cardiorespiratory Coordigram I Figure: An exemplary Coordigram. 7 / 19

8 Interpreting the Cardiorespiratory Coordigram Interpreting the Cardiorespiratory Coordigram II Figure: An exemplary coordigram. Horizontal parallel lines imply coordination. 8 / 19

9 Interpreting the Cardiorespiratory Coordigram Interpreting the Cardiorespiratory Coordigram III Figure: An exemplary coordigram. Horizontal parallel lines imply coordination. For t < 0 the heart triggers the respiration. For t > 0 the respiration triggers the heart. 9 / 19

10 Cheyne-Stokes Respiration (CSR) I Figure: Periodic Respiration of a patient with Cheyne-Stokes Respiration. Central apneas are followed by increasingly deeper breaths which then transition to central apneas again. 10 / 19

11 Cheyne-Stokes Respiration (CSR) II Periodic Respiration Central apneas, dysfunction of the respiratory center often associated with severe forms of heart failure 1,2 adverse prognostic implications 2,3 Possible Therapeutic approach: Adaptive Servo-Ventilation 4 Successful therapy of CSR increased mortality 1 T. D. Bradley, et al. Sleep Apnea and Heart Failure - Part I: Obstructive Sleep Apnea. In: Circulation Part II: Central Sleep Apnea. In: Circulation T. Bitter, et al. Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. In: European Heart Journal M. R. Cowie, et al. Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. In: New England Journal of Medicine / 19

12 Those Darn Pacemakers Figure: Data of a CSR-Patient with CRT-ICD (Cardiac Resynchronization Therapy and Implantable Cardioverter-Defibrillator). 12 / 19

13 Case Study: Patient X Male Patient Age: 61 years BMI: 24.5 kg m 2 no pacemaker 13 / 19

14 Synchrogram vs Coordigram Synchrogram vs Coordigram I Figure: Synchrogram (b) and Coordigram (c) during an episode of CSR. 14 / 19

15 Synchrogram vs Coordigram Synchrogram vs Coordigram II Figure: Synchrogram (b) and Coordigram (c) during an episode of CSR. Apneas are marked in red. 15 / 19

16 Synchrogram vs Coordigram Synchrogram vs Coordigram III Figure: Synchrogram (b) and Coordigram (c) during an episode of CSR. Areas of horizontal lines are marked in red. They imply synchronization (b) or coordination (c). 16 / 19

17 Fourier-Method Fourier-Method Figure: Estimate the point distribution over a certain timewindow. 17 / 19

18 Fourier-Method Fourier-Method Figure: Analysis of the coordigram using the Fourier-Method 1. 1 M. Riedl, et al. Cardio-Respiratory Coordination Increases during Sleep Apnea. In: PLoS ONE (4) e / 19

19 Future Research Verification using surrogate data other methods of quantifying the coordigram influence of sleepstages Circadian Rhythm age BMI... on cardiorespiratory coordination Goal: Extension to more CSR-patients (without pacemaker!) 19 / 19

20 Future Research Verification using surrogate data other methods of quantifying the coordigram influence of sleepstages Circadian Rhythm age BMI... on cardiorespiratory coordination Goal: Extension to more CSR-patients (without pacemaker!) Thank you for your attention! 19 / 19